Diaphragmatic factors include the elevation of the right hemidiaphragm
, such as eventration or phrenic nerve injury, and the hepatic factors include atrophy of the liver due to cirrhosis or congenital etiology (atrophic or small liver, segmental agenesis of the right lobe of the liver).
The arrangement (similar to that of a laparoscopic cholecystectomy or splenectomy) allows for examination of the posterior portion of the right hemidiaphragm
and almost the entire left hemidiaphragm
in addition to routine abdominopelvic exploration.
Following cervical dislocation, the hemidiaphragm
was dissected with the phrenic nerve.
The bleeding focus was a laceration wound with continuous oozing at the dome of right hemidiaphragm
about 3 cm in length.
A CT scan of the abdomen and pelvis, with intravenous contrast, showed a loop of colon interpositioned between the liver and the right hemidiaphragm
, mimicking free air.
Pleural effusion imaging characteristics (*) Volume (mL) Imaging characteristics 5 Detectable on lateral decubitus 50 Posterior costophrenic sulcus blunting 200-500 Lateral costophrenic sulcus blunting Tracking along pleural surface Meniscus sign Massive effusion Opacification of hemithorax and shift or inversion of hemidiaphragm
(*) Adapted from Qureshi NR, Gleeson, FV.
congenitally has a weaker structure than the right side, and the liver serves as extra protection for right side; that is why trauma is more likely to rupture the left diaphragm especially in children .
An area of consolidation is also seen in right middle zone with raised right hemidiaphragm
Chest x-ray showed parenchymal and pleural changes in the base of the left lung obscuring the hemidiaphragm
was better evaluated by the cervical approach.
The right hemidiaphragm
appeared elevated partly because of the accumulation of fluid in the pleural space.
The open lymphatic lacunae on the under surface of the right hemidiaphragm
and the lymphoid aggregate in the omentum absorb fluid, leading to bulky accumulations of concentrated mucus.